Will California TPA’s Survive? Are Self-Funded Plans Threatened Nationally?

If California passes a new proposed stop loss insurance mandate, and it appears it will, some TPA’s within the sate will be hard pressed to survive. Their small group accounts will flee to the fully-insured market, or drop their health plans completely. Will other states follow California’s example?

http://smarthr.blogs.thompson.com/2012/06/06/plan-attorneys-see-trend-against-self-funding/

 

 

 

Health Care Is A No-man’s-land – Take Advantage Of The Chaos

Health care costs are an anomaly. Costs vary significantly from one provider to the next. PPO’s contract varying reimbursement levels with willing providers – one MRI center may contract at $300 while another five minutes away will contract with the same PPO network, for the same procedure, for $1,800 (we personally experience this wild pricing difference).

PPO’s are pressured by consumers to include everyone they can in their networks, to hell with the costs. PPO’s have become agents for hospitals and many receive financial rewards through lucrative side agreements. PPO’s are not your friends and are not looking after your financial interests.

Although many find health care pricing opaque, hard to quantify or even identify in advance of service to be rendered, it is possible to do so with hard work and persistance. Data is readily available for those with the patience to look for it.

Taking advantage of the Chaos in Health Care will save a self-funded health plan a minimum of 40%, with some cases achieving savings of 60% in real claim dollars.

Editor’s Note: “The Company That Solved Health Care” is a must read.